The intersections of palliative care and homelessness in social policy: A content analysis of Canadian policy documents.

Background: Palliative care for people experiencing homelessness (PEH) is a social issue of increasing importance. Policymakers are best positioned to lead societal responses by naming the issue in policy documents, allocating resources to address palliative care for PEH, and creating frameworks or guiding principles to inform action. This study aims to examine how, if at all, policymakers in Canada are identifying and addressing the issue of palliative care for diverse PEH in policies and frameworks governing the palliative care and/or homelessness sectors.

Methods: We conducted a content analysis of 75 Canadian policy documents governing palliative care or homelessness for the presence of discussion of homelessness (in palliative care documents) and end-of-life (in homelessness documents). The level of discussion (no, indirect, minimal, significant), the jurisdictional level (municipal/city, provincial/territorial, national), and mention of intersecting identities were also recorded.

Results: Of the 75 documents analyzed, 42 contained no discussion of palliative care and homelessness, and only five contained significant discussions by explicitly identifying barriers, describing unique needs, and identifying competencies or innovative practices to promote access and inclusion. All significant or national level discussions were palliative care documents. Intersectional discussions of palliative care for PEH were found in 9 of 75 of documents, with ethnicity and Indigeneity mainly mentioned in palliative care documents, and older age and gender mentioned solely in homelessness documents.

Conclusions: There are critical gaps in Canadian policy documents governing palliative care and homelessness. Most policy documents fail to name or address the issues, with the gap most pronounced in homelessness documents, which contained no national level or significant discussions about end-of-life. Additionally, policy documents from both sectors seldomly discussed the unique needs and barriers of older, racialized, and/or gender-marginalized PEH at end-of-life. While competencies and service level solutions appear to be emerging within palliative care policies at the national level, policymakers from both sectors and across all levels of government must collaborate to address the unique needs of diverse PEH at end-of-life.